Emergency departments had their busiest month ever in normally quiet January - raising fears that hospitals may not cope with the lethal strain of flu set to hit our shores this winter.
Population growth is being blamed for the flood of patients, with more sick people, more injured and more elderly all adding to the numbers. Staff say they are stressed, exhausted and overworked, and some feel they are propping up the DHBs at the expense of their health.
Counties Manukau District Health Board , chief executive Dr Gloria Johnson told the board this week South Auckland's Middlemore Hospital had its highest-ever number of patients showing up in emergency in January and "that's been mirrored across metropolitan Auckland".
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After an extremely busy winter last year for the Auckland, Counties Manukau and Waitematā DHBs, emergency numbers kept trending upwards until summer, Johnson said.
"Really early, exceptionally high and exceptionally sustained" numbers to the emergency department clogged all three DHBs. Auckland DHB normally closes beds down over summer but was unable to do so this year, Johnson said.
Several strains of influenza including the lethal "Aussie flu" are due to hit New Zealand, so this year's winter admissions are expected to be higher still. Flu season has overloaded the system in the UK and USA, where hospitalisation rates are worse than during the swine flu epidemic.
"If we have that then we're not only going to have an exceptionally busy winter - we're going to have very, very sick people in our hospitals," Johnson said. "That's going to put pressure on our entire system."
Counties Manukau had been exceeding the Government health target of 95 per cent of patients staying less than six hours in the emergency department, but in recent months had only hit 92 per cent. The hospital was too full to move patients to the appropriate department, Johnson said.
"This is not a measure of efficiency of our emergency department. It's a measure of the efficiency of the whole hospital."
Pharmac announced on Wednesday a beefed-up flu vaccine would be available in April, designed to protect against four strains of the flu circulating in the UK. DHB chiefs are crossing their fingers it will work.
Johnson said fears about being overwhelmed in flu season were part of what drove the bosses of the three DHBs to give an unusually frank presentation to Parliament's health select committee last week.
They were in Parliament to plead their case for a share of the $8 billion of extra health spending Labour has pledged over the next four years.
Outgoing DHBs chairman Lester Levy painted a picture of a system at breaking point, saying there was "very little resilience, if any, in the system".
He questioned whether the public health system had the resources to deal with a pandemic.
Primary care providers said they had warned for a decade a "perfect storm" was coming for hospitals, especially in the upper North Island.
A 2009 report from the Pinnacle Midlands Health Network - a non-profit network of central North Island GPs - predicted shrinking GP numbers would collide with a growing and ageing population to swamp secondary care services.
John Macaskill-Smith, Pinnacle's chief executive at the time, said it was frustrating to see DHBs "acting like this is a big surprise".
He accused DHBs of "overfunding hospitals and underfunding primary healthcare".
"Once people are in hospital it's too late. We said it would happen 10 years ago and they've done nothing to stem it."
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Minister of Health Dr David Clark reiterated that there would be another $8b for health over the next four years, but details would not be revealed until the Budget was announced in May.
But Clark confirmed it would include measures to make GP visits cheaper. Last year's New Zealand Health Survey found 500,000 people could not afford the GP visits they needed.
"Many of those people will have gone on to get sicker and some will have ended up in hospital when early intervention might have prevented it," Clark said.
"I want New Zealanders to be able to afford to go to the doctor when they need to."
New Zealand Resident Doctors' Association national secretary Deborah Powell said the problem of busy waiting rooms and emergency departments was not just in Auckland, it was in Northland, as well as down south.
"We are just inundated. It started last year and it didn't let up."
More people were coming in at peak periods and more people were coming in at what was usually off-season periods.
Over the period of summer, ED's usually saw a reduction in demand but there was no reduction last year and numbers in winter had been above normal as well.
"The pressure is on the whole of our health system, the pressure in Auckland is unheralded, they reached breaking point in Summer.
"We just can't keep doing this, it is patient demand and it is population driven."
More money was needed for more staff, she said.
She said that the Government's proclamation that a lot of people coming into emergency rooms could be seen via community care, to ease pressure on emergency rooms, was wrong.
"These people coming in are needing to be admitted. They need hospital care."